By: Beth Walsh for Uterus1
Non-emergency Caesarean delivery increases maternal and fetal risk, making its widespread and increasing use unjustified, according to a report from the World Health Organization. A C-section birth doubles the risk of severe maternal morbidity and elective procedures add another 30 percent to the risk. A C-section delivery also doubles an infant’s risk of having a prolonged stay in the intensive care unit.
|Here are steps you can take to avoid an unnecessary C-section:|
Select your care provider wisely. Ask your obstetrician or midwife their primary Cesarean rate (the number of first-time mothers who deliver by C-section); it should be below 10 percent. Research your hospital’s C-section rate as well because its labor and delivery policies also affect the likelihood of Cesarean delivery.
Educate yourself about labor and birth. Most hospitals offer birthing classes, and there are numerous books and videos available on the subject. The more you know, the more comfortable you are likely to be with the process.
Avoid induction of labor. This can lead to an increased Cesarean rate, especially for first births. Nowadays, many births are induced for convenience of either the patient or the doctor. Be aware that this can increase your chances of C-section.
Although there are certainly situations in which a C-section is appropriate, the Public Citizen Health Research Group has estimated that half of the nearly one million cesareans performed every year are medically unnecessary.
The researchers said that increased use of Caesarean delivery worldwide has not resulted in “any clear overall benefit for the baby or mother but is linked with increased morbidity for both.” They found that a Cesarean delivery improves outcomes only in the case of a fetus in the breech position.
In the United States, the Caesarean-delivery proportion of all live births increased from 20.7 percent in 1996 to 30.2 percent in 2005, according to the National Center for Health Statistics.
The researchers reviewed data from a 2005 WHO global survey of maternal and fetal health. After excluding all emergency Caesarean deliveries, the investigators focused on 94,307 vaginal and Caesarean deliveries. Approximately one-third (31,821) involved non-emergency Caesareans. The principal outcome parameters were maternal, fetal, and neonatal morbidity and mortality.
The most common indications for elective procedures were previous Caesarean delivery (44%), breech presentation (12%), pre-eclampsia (13.5%), other maternal complications (12%), and tubal ligation (7.4%).
The overall rate of maternal morbidity and mortality was 1.8 percent among women who had vaginal deliveries. In contrast, the rate was 5.5 percent in patients who had an elective Caesarean delivery and four percent among those who had intrapartum procedures. The difference between vaginal and Caesarean delivery translated into an adjusted odds ratio of 2.0 for intrapartum procedures and 2.3 for elective procedures.
The risk of each maternal adverse event (death, admission to ICU, blood transfusion, or hysterectomy) was significantly increased in patients who had Caesarean deliveries. The need for antibiotic therapy after delivery was five times higher in the Caesarean-delivery group.
Non-emergency Caesarean procedures doubled the likelihood that a baby would require an ICU stay of seven days or longer, and the mortality risk was 70 to 90 percent greater. The only clear-cut benefit was a significantly reduced risk of fetal death associated with breech presentation.